The two
overarching goals of population health improvement are improving overall health
and reducing disparities. Successive generations of Americans enjoyed upward
trends in life expectancy and improved general health during the twentieth
century. However, in spite of the technological advancements in modern medicine
and escalating health care expenditures, disparities in longevity based on
race/ethnicity and educational attainment remain persistent and damaging to our
society. This article by a distinguished group of investigators from the
MacArthur Research Network on an Aging Society quantifies these life expectancy
disparities in terms of race and education level, using data from NCHS as well
as the American Community Survey (the largest household survey in the U.S.). Investigators
found the largest disparity in life expectancy at birth to be between highest
educated whites and lowest educated blacks: 14.2 years for males and 10.3 years
for females (2008 data). The authors
found that while race plays a role in longevity, education level is even more
important across all groups, except Hispanic females. Educational attainment at
age 25 correlated more strongly with expected life years, both within and among
racial groupings. For example, highly educated blacks had a life expectancy 7.5
years higher than their less educated white counterparts, which defies the overall
racial disparity.

To summarize, the authors conclude that this has led to two
Americas, “demarcated by level of education and its
socioeconomic status correlates, and related to race or ethnicity.” While the authors
acknowledge that racial disparities have been narrowing in the last few
decades, they express concern that the gap could expand since improving life
expectancy of lower educated individuals “is particularly difficult for those
who have already passed the phase in which formal education normally occurs.”
They argue that enhanced educational investment at all ages -- lifelong learning
-- will be required to protect and build on progress on disparity improvement.

Journals we follow:

American Journal of Preventive Medicine

American Journal of Public Health

Annual Review of Public Health

Health Affairs

Journal of the American Medical Association (JAMA)

Journal of Epidemiology and Community Health

Journal of Health and Social Behavior

Milbank Quarterly

New England Journal of Medicine

Preventing Chronic Disease

Social Science and Medicine

David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.